Priority-setting processes for medicines: the United Kingdom, Australia and New Zealand

The agencies involved in the assessment and prioritisation of medicines for public subsidy purposes in Australia, England and Wales, and New Zealand are compared in terms of their processes; ultimate decision-maker and political involvement in decisions; price-setting processes; decision criteria and inclusion of economic assessment of cost-effectiveness; provision for the rule of rescue and separate treatment of potentially life-saving medicines and cancer drugs; levels of access; extent of consumer participation in processes and decisions; and provision for appeal from decisions. All countries face the key challenge of expanding access to important new treatments, while maintaining cost-effectiveness as a key criterion for public funding and safeguarding the affordability and sustainability of their programs into the future. New Zealand's model may have led to a greater focus on cost-containment and overall affordability than those of the other two agencies. Despite controversial decisions that have led on occasion to disappointment and challenge, the Australian and New Zealand agencies have survived and appear to have managed to date to maintain public and political support. By contrast, the United Kingdom's National Institute for Healthcare and Clinical Excellence is facing major changes to its role that could see it become more of an advisory organisation.     

Place-Based Leadership and Public Service Innovation

This article discusses two matters that are becoming increasingly important in debates about local government: place-based leadership and public service innovation. The troubling international economic outlook means that many local authorities are focusing on ‘efficiency savings’ and the prevailing mantra in public policy circles is ‘do more with less’. This article questions this approach. It aims to contribute to what one chief executive described to us as ‘more with more’ thinking. This approach strives to release the community and business energies of a locality. If this can be achieved the total resources available to improve the local quality of life can be increased, even if state spending is shrinking. A conceptual framework for studying place-based leadership is presented. This distinguishes three, overlapping realms of leadership in any given locality – political leadership, managerial/professional leadership, and community and business leadership. It is argued that the areas of overlap between these realms can be viewed as innovation zones – spaces in which established approaches can be questioned and new trajectories developed. These zones can, however, also become conflict zones with little learning and exchange taking place. Place-based leadership can influence whether such political spaces are used to promote creative problem solving or whether they become arenas for dispute and friction between sectional perspectives. By drawing on a study of the current Digital+Green initiative in Bristol, UK, the article suggests that an imaginative approach to place-based leadership – one that accepts intelligent risk taking – offers potential for improving the local quality of life as well as strengthening local democracy.     

Addressing the legitimacy of the council-manager executive in local government

This article uses the concept of legitimacy to contribute to the debate about leadership change in local government. It focuses on the council-manager form of executive, used in Australia, Ireland, Finland, New Zealand, the US, and was an option for English local authorities in the Local Government Act 2000. After reviewing the central features, underlying values, and variations that the council-manager model displays cross-nationally, the article draws on research carried out in Stoke-on-Trent, England, a city which adopted a variant of the council-manager form. The analysis assesses the model operating there in terms of legitimacy, and argues that some of its shortcomings are addressed by the introduction of a form of decentralised, deliberative, neighbourhood governance.     

Gang activity in english prisons: The staff perspective

Abstract

Gang behaviour has been associated with serious problems in American prisons (e.g., Fong and Buentello, 1991). This study explored the possible existence of indicators of gang activity in English prisons. Surveys of problems consistent with gang activity were completed by 374 prison staff in 16 prisons that were representative of the English Prison Estate. Results showed significant differences between categories of institution. The most gang-related activity was reported in male Medium security prisons and Young Offender Institutions. The lowest reported incidence was in both male Low and High security prisons. Female establishments demonstrated levels lower only than Medium security male prisons. Discussion focuses concern on the levels of gang activity apparently present in the Medium security English Prisons and suggests directions for further research.     

Retrospective reports of parental partner abuse: Relationships to depression,trauma symptoms and self-esteem among college students

This study tested whether retrospective reports of childhood exposure to parental partner abuse were associated with internalizing aspects of adult adjustment. Participants were 550 men and women college students. Among women, childhood exposure to partner abuse was related to depression, trauma-related symptoms, and low self-esteem; among men, exposure was associated with trauma-related symptoms. These relationships were statistically independent of reported parental alcohol abuse and divorce. Relationships of parental partner abuse to low self-esteem and depression among women were also independent of variation in retrospective reports of child sexual and physical abuse. However, the relationship of partner abuse to trauma-related symptoms depended, in part, on the co-occurrence of child abuse. The discussion addressed implications of the findings for future research and for clinical practice.     

Gender and colonialism: Women's organisation under the Raj

The popular media have recently born witness to a renewed interest in India under British rule. This article examines the portrayal of Indian liberation struggles in two of the more serious expositions, The Jewel in the Crown and Gandhi, questioning the political implications of this portrayal. It shows that they both neglect the crucial role played by women in the maintenance and demise of the Raj. We argue that women's contribution was so significant that its omission constitutes a misrepresentation of history that can fairly be termed revisionist. We suggest that the reason for this process of mystification lies in the relevance of India's fight for national liberation and sexual equality in the early twentieth century, to present day struggles against imperialism and male domination, which are two of the most explosive issues affecting the modern Western world.     

“She has done me no work”: language and power asymmetry in impoverished families in Poland

Based on an in-depth semantic analysis of interviews with poor Polish couples living in a foreclosed state farm and the examination of the so-called “linguistic sexism” of the Polish language, the author shows that despite a manifest change in the social context of poor households, power relations within impoverished rural married couples still remain the same. The traditional power imbalance can be observed at the level of the respondents’ utterances, especially with regard to gender roles, work and household duties, dowries and inheritance. In households with downwardly mobile men, husbands tend to assert even more symbolic power than in households in which the husbands have jobs, even if low-paying ones. Wives of downwardly mobile men in the community studied are inclined to verbally support their husbands and patriarchal family relations, despite the fact that often the traditional basis of patriarchy—economic providership—is now women’s responsibility also.